A look at change in California vaccination rules

Health authorities in California have more power to insist that a dog is vaccinated against rabies than to ensure that a child enrolled in public school is vaccinated against measles.

That’s just one of the frustrations faced by health officials in the first year after California did away with “personal belief exemptions” that allowed parents to send their kids to school unvaccinated, according to a study published Monday in the journal Pediatrics.

In the 2014-15 school year, when parents could still opt out of vaccinations for any reason they chose, only 90.4 percent of kindergarteners in California public schools were fully immunized. That’s below the 94 percent threshold needed to establish community immunity for measles, according to experts.

Gaps like that helped persuade state lawmakers to pass Senate Bill 277, which was signed into law in 2015. It requires every child taught in public school classrooms to be fully immunized against 10 diseases: diphtheria, hepatitis B, haemophilus influenzae Type B, measles, mumps, pertussis (a.k.a. whooping cough), poliomyelitis, rubella, tetanus and varicella (a.k.a. chickenpox) — unless a doctor provides a medical reason for why it would be unsafe to do so.

It was the first time in 35 years that a state had gotten rid of personal belief exemptions, and it made California only the third state — along with Mississippi and West Virginia — to have such a strict requirement.

By the most basic measure, it worked. In the 2017-18 school year, 95.1 percent of kindergarteners had all of their immunizations, according to the California Department of Public Health.

However, the elimination of personal belief exemptions was offset to some degree by an increase in medical exemptions. Before the passage of SB 277, only 0.2 percent of students had a medical exemption, the health department said. By 2017-18, that figure had more than tripled, to 0.7 percent.

Part of that increase was legitimate, the study authors explained: Some parents whose children could have qualified for medical exemptions obtained personal belief exemptions instead because they were easier to get.

But many of the additional medical exemptions were bogus, health officials suspect. Though they’d like to crack down and see more kids get vaccinated, there are numerous obstacles in their way, the new study revealed.

The authors, led by Salini Mohanty of the University of Pennsylvania, reached out to members of the Health Officers Association of California to get their perspective on SB 277. Forty people responded, including immunization coordinators, communicable disease directors and public health nurses. Together, they represented 35 of California’s 61 local health jurisdictions.